Medical educational presentation

1. STAPLERS IN SURGERY
DR SHIVAM M PANDEY
2ND YEAR PG SURGERY RESIDENT
BSAMCH, DELHI

2. HISTORY OF SURGICAL STAPLERS
1880
First stapler by Dr henroz - everted bowel anastomosis in dogs.
1908
Prof. humer hultl with victor fischer created a stapler with emphasis of following principles-
tissue compression
B- shaped Configuration of closed staples
Replacement of steppers in double staggered row
Use of fine wires as staple material
But it was heavy and its assembly was difficult and time consuming

3. 1980
The down of minimally invasive procedures. surgeons request laparoscopic
adaptation of transacting linear cutter device
1989
Titanium replaces stainless steel as the key Component of staples.

4. Properties of tissue
● Living tissue mainly consists of solid and fluid (biphasic nature)
● Tissue thickness changes when external force is applied then tissue also has
properties to return to the original shape overtime (viscoelastic nature)
● Based on biphasic and visco-elastic nature when using stapler we have to
consider
…..
Thickness
Compressibility
Property variability

5. Materials for staplers
● Stainless steel
● Pure titanium
● Titanium alloy

7. Pre-compression
● Pre compression is necessary for good staple formation.
Holding compression before firing:Tissue thickness varies widely throughout
the body from organ to organ
● Prepare the tissue to be fired upon
● Reduces stress on the tissue prior to firing
● Minimises tissue flow
● optimises staple formation
15 to 20 seconds gives an optimal thickness
Tissue thickness varies widely throughout the body from organ to organ

12. Modern stapler types
● Linear staplers
● linear cutting
● circular Staplers
● Curved cutter
● Skin

13. Linear staplers
● Close internal organ prior to transaction
● Close the common opening or enterotomy after the creation of an
anastomosis.
● Biopsy or wedge resection of the lung and closing of the bronchus and to
close pulmonary vessels prior to their division.

14. Linear cutting staplers
● Open linear cutter
without selectable height
with selectable height
● endoscopic linear cutter
endoscopic articulating linear
Powered articulating endoscopic linear cutter

16. Features benefits
6 row 3D staple technology Optimises tissue compression and provides
superior hemostasis
selectable staple height allow surgeon to choose close staple height
without changing reload
proximal preload support consistent staple formation without fork
deflection
two sided firing ambidextrous use of instrument
intermediate locking position allow repositioning of tissue
safety lockout mechanism prevent firing if there is no cartilage or fired
cartilage
non slip grip surface tighter and stronger grip

18. ENDOSCOPIC LINEAR CUTTER

19. ENDOSCOPIC ARTICULATING LINEAR CUTTER

20. POWERED ARTICULATING LINEAR CUTTER

21. Enhanced system wise compression
Pre compression :
management of tissue before firing
3 point gap control:
ensures alignment and calibration throughout the staple line for consistent staple
formation and Hemostasis
Precision Machine anvil: Removes exudative fluid and prepare for proper staple
formation.
FEATURES

22. Stroke firing system: distributes for evenly
Articulating joint: for lateral access
Manual override: in surgeon control, in event of power loss
Anvil jaw release
Knife reverse switch:discontinue firing and reverse the knife
Battery pack: Should be pre installed before use.

28. Curved and straight intraluminal staplers are anastomotic staplers available in four
sizes to permit proper matching of instrument to diameter of the lumen
● 21mm
● 25mm
● 29mm
● 33mm
single fire instruments and single patient use
Panther Dolphin Circular Stapler in service video

29. Uses
End to end anastomosis colorectal anastomosis in LAR.
End to side Anastomosis eg. ilio-colostomy after right hemicolectomy
Side to side Anastomosis eg. side to side gastrojejunostomy after Billroth II
gastrectomy
Rapid creation of pyloroplasty.

30. Curved cutter Stapler
Curvilinear cutting staplers (contour stapler)
trans-abdominal proctectomy
very low anterior resection of the rectum.

31. Features and benefits
Simultaneous stapling and cutting
Innovative device delivers 4 curvilinear rows of Staples with a single cut between
eliminating two procedure steps , the need for a bowel clamp and scalpel
Unique curved head design
Delivers lower pelvic access with enhanced visibility it also allows placement of 40
mm staple line in the width of 30 mm space.
Ease of placement
Confirms the natural anatomy of the pelvis.

32. Lower pelvic access
for the narrow pelvis the contour exceed the access of 30 mm linear stapler
reloadable cartridges
a single device for up to six firings in a single procedure.
Multiple-Fire Surgical Curved Cutter Stapler: Focus On Complete Distal
Transection

33. Skin staplers

34. PPH

40. Anastomotic leak
Mechanical/tissue causes-
seen in first two days following surgery more commonly seen.
Ischemic causes-
leaks happens five to seven days post-operatively.

41. Advantages of stapling devices
● Less tissue handling and less tissue tension
● less trauma
● times saving
● better hemostasis
● available for MIS

42. Contraindications
● If circular head greater diameter than lumen diameter.
● Tissue in tension .
● Different lumen diameter.

43. Types of staplers based on usage
● Reusable staplers with disposable cartridges.
● Disposable cartridges.

44. ● The use of stapling does not guarantee the successful outcome of surgical
procedure.
● Effective and safe use of mechanical stapling devices depends upon
good basic surgical technique including clean and atraumatic dissection
careful hemostasis attention to the tissue condition
blood supply and creation of tension free anastomoses.
“If you wouldn't sew it don't staple
it”

45. THANK YOU

47. Without selectable height With selectable height
4 row of B formation 6th row of 3D technology
no selectable height selectable height
one sided firing two sided firing
no gripping surfaces gripping surface
preloaded and total eight firings no preload total 12 firings